ularly for women. An emphasis on deference, passiv-
ity, and politeness should not be confused with a de-
pendent personality disorder. Cultures that value
work and productivity may produce citizens with a
strong emphasis in these areas; this should not be con-
fused with obsessive-compulsive personality disorder.
Certain personality disorders, such as antisocial
and schizoid personality disorders, are diagnosed
more often in men. Borderline and histrionic person-
ality disorders are diagnosed more often in women.
Social stereotypes about typical gender roles and be-
haviors can influence diagnostic decisions if clinicians
are unaware of such biases (Tredget, 2001).
TREATMENT
Several treatment strategies are used with clients
with personality disorders; these strategies are based
on the disorder’s type and severity or the amount of
distress or functional impairment the client experi-
ences. Combinations of medication and group and in-
dividual therapy are more likely to be effective than is
any single treatment (Tredget, 2001). Not all people
with personality disorders seek treatment, however,
even when significant others urge them to do so. Typ-
ically people with paranoid, schizoid, schizotypal, nar-
cissistic, and passive-aggressive personality disorders
are least likely to engage or remain in any treatment.
They see other people, rather than their own behav-
ior, to be the cause of their problems.
Psychopharmacology
Pharmacologic treatment of clients with personality
disorders focuses on the client’s symptoms rather than
the particular subtype. The four symptom categories
that underlie personality disorders are cognitive-
perceptual distortions including psychotic symptoms;
affective symptoms and mood dysregulation; aggres-
sion and behavioral dysfunction; and anxiety. These
four symptom categories relate to the underlying tem-
peraments that distinguish the DSM-IV-TR clusters
of personality disorders:
- Low reward dependence and cluster A dis-
orders correspond to the categories of affective
dysregulation, detachment, and cognitive dis-
turbances (Rivas-Vasquez & Blais, 2002). - High novelty seeking and cluster B disorders
correspond to the target symptoms of impul-
siveness and aggression. - High harm avoidance and cluster C disorders
correspond to the categories of anxiety and
depression symptoms.
Cognitive-perceptual disturbances include mag-
ical thinking, odd beliefs, illusions, suspiciousness,
ideas of reference, and low-grade psychotic symp-
toms. These chronic symptoms usually respond to
low-dose antipsychotic medications (Rivas-Vasquez
& Blais, 2001).
Several types of aggression have been described
in people with personality disorders. Aggression may
occur in impulsive people (some with a normal elec-
troencephalogram, some with an abnormal one); peo-
ple who exhibit predatory or cruel behavior; or people
with organic-like impulsivity, poor social judgment,
and emotional lability. Lithium, anticonvulsant mood
stabilizers, and benzodiazepines are used most often
to treat aggression. Low-dose neuroleptics may be use-
ful in modifying predatory aggression (Rivas-Vasquez
& Blais, 2002).
Mood dysregulation symptoms include emotional
instability, emotional detachment, depression, and
dysphoria. Emotional instability and mood swings re-
spond favorably to lithium, carbamazepine (Tegretol),
valproate (Depakote), or low-dose neuroleptics such
as haloperidol (Haldol). Emotional detachment, cold
and aloof emotions, and disinterest in social relations
often respond to selective serotonin reuptake in-
hibitors (SSRIs) or atypical antipsychotics such as
risperidone (Risperdal), olanzapine (Zyprexa), and
quetiapine (Seroquel). Atypical depression is often
treated with SSRIs or monoamine oxidase inhibitor
antidepressants (MAOIs) or low-dose antipsychotic
medications (Pharmacology Update, 2002).
Anxiety seen with personality disorders may be
chronic cognitive anxiety, somatic anxiety, or severe
acute anxiety. Chronic, constant anxiety responds to
SSRIs and MAOIs, as does chronic somatic anxiety, or
anxiety manifested as multiple physical complaints.
Episodes of acute, severe anxiety are best treated with
MAOIs or low-dose antipsychotic medications.
Table 16-1 summarizes drug choices for various
target symptoms of personality disorders. These drugs
including side effects and nursing considerations are
discussed in detail in Chapter 2.Individual and Group Psychotherapy
Therapy helpful to clients with personality disorders
varies according to the type and severity of symptoms
and the particular disorder. Inpatient hospitalization
usually is indicated when safety is a concern, for
example, a person with borderline personality dis-
order who has suicidal ideas or engages in self-injury.
Otherwise hospitalization is not useful and may even
result in dependence on the hospital and staff.
Individual and group psychotherapy goals for
clients with personality disorders focus on building
trust, teaching basic living skills, providing support,
decreasing distressing symptoms such as anxiety,
and improving interpersonal relationships. Relax-378 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS